A.Yu. Ulitin, V.E. Olyushin, B.I. Safarov, E.A. Gogoleva
Polenov Research Neurosurgical Institute, Saint Petersburg, Russia
There were 108 cases with primary tumors of the thalamus, operated in 1992-2008. Glioblastoma, anaplastic astrocytoma and astrocytoma with a small degree of anaplasia were diagnosed in 22 (20.4%), 47 (43.5%) and 39 (36.1%) of cases, respectively. The number of patients, aged 20-40, was the greatest (52.7%). Transcortical (90% of cases) and infratentorial (7%) approaches were used. We performed the following operations: total removal – 24 cases (22.2%), subtotal removal – 30 cases (27.7%), partial removal – 28 cases (25.9%), stereotaxic biopsy – 22 cases (20.4%) and biopsy – 4 cases (3.7%). Ventriculo-peritoneal by-pass was applied before and after operation in 5 (4.6%) and 25 (24.7%) patients, respectively. Postoperative mortality was 6.5%. There were no deaths among cases, subjected to stereotaxic biopsy. Postoperative radio- and chemotherapy were carried out according to a standard mode.
Mean survival of cases with glioblastoma was as follows: total removal – 6.3 months, subtotal removal – 8.5 months, partial removal and biopsy - 5.5 months, stereotaxic biopsy – 5.9 months. As for cases with anaplastic astrocytoma, these indices were 7.4, 7.5, 5.4 and 3.8 months, respectively. They were 32, 21.5, 13.2 and 7.3 months in cases with astrocytomas and anaplasia of the 1st-2nd degree, respectively.
Mean life of cases with benign gliomas, subjected to stereotaxic biopsy, was low (7.3 months) as compared with patients, who had undergone total and subtotal removal (32 and 21.5 months, respectively). These results justify use of more aggressive surgical treatment of such cases.